The study was performed at the premises of Department of Nephrology and Dialysis, Pavlov University, St. Petersburg, Russia Objective. Assessment of the relationship between the blood serum tumor necrosis factor α (TNF-α) level and indicators of protein-energy malnutrition in patients on program hemodialysis (PH).
Material and methods. 645 patients on PH, including 300 men and 345 women aged 56.8±12.8 years were examined. All patients received treatment with program hemodialysis for 8.4±5.3 years. The assessment of nutritional status for the purpose of diagnosing protein-energy malnutrition (PEM) was performed using the method proposed by ISRNM (International Society of Renal Nutrition and Metabolism). Determination of the blood serum TNF-α level was carried out using a method based on a three-stage "sandwich" version of enzyme-linked immunosorbent assay with mono- and polyclonal anti-TNF-α antibodies using commercial kit "alpha-TNF ELISA-BEST", Vector-Best Company, Russia, in accordance with the manufacturer's instructions. Reference values for TNF-α were 0–8.1 pg/mL.
Results. The prevalence of PEM diagnosed by the ISRNM method was 24.9% (160 patients). Mean values of TNF-α in patients without signs of PEM were 7.11±3.02, and in patients with PEM they were more than twofold higher - 19.5±5.9 (P<0.001). Patients with elevated TNF-α levels showed statistically significantly lower values of the main indicators of PEM (body mass index, skeletal muscle mass index, percentage of body fat, as well as total protein, albumin, prealbumin, total cholesterol, transferrin, and the number of blood lymphocytes) than in patients with normal TNF-α levels. A significant relationship between the adequacy of the HD dose (spKt/V) and the TNF-α level was not revealed, which was confirmed, in particular, by the Spearman correlation coefficient (Rs=0.012; P=0.754). At the same time, no relationship was found between the TNF-α level and the duration of HD (Rs=0.038; P=0.328).
Conclusion. The prevalence of PEM diagnosed by the ISRNM method in patients on PH was 24.9%. An increase in the blood serum TNF-α level may be an important pathogenetic link in the development of PEU in patients receiving treatment with PH.

Keywords: protein-energy malnutrition, program hemodialysis, chronic inflammation, tumor necrosis factor-α